Member Advocate

TruHealth • Dallas, TX

1d

About The Position

American Health Advantage is seeking a customer-service-focused leader to support local service areas. The Member Advocate supports members after enrollment, coordinating with Insurance Producers to help ensure a seamless transition and serving as a point of contact for members and their families. The role provides frontline support to members, partner facilities, and integrated care teams, while helping ensure member and plan needs are met.

The Member Advocate is responsible for a group of nursing facilities and must ensure that required services are provided to each member in the assigned group. The position also supports regional network development, maintains member and facility tracking reports, follows up on member concerns, and ensures all member interactions comply with CMS regulations.

Requirements

• Experience working successfully in a healthcare delivery setting with elderly patients as a clinician, social worker, or caregiver.
• Exceptional interpersonal skills and the ability to work independently and as part of a team.
• Strong listening skills to understand feedback raised by members' families.
• Ability to work effectively with nursing staff, doctors, and administration staff at nursing homes in the assigned region.
• Ability to deliver outstanding customer service, with a proven track record.
• Ability to comply at all times with CMS regulations regarding Medicare Advantage Plans.
• Exceptional organizational skills.
• Strong written and verbal communication and clear-thinking skills, including the ability to synthesize complex issues into simple messages.
• Willingness and ability to travel to facilities within the assigned region.
• Dependable transportation, a current driver's license, a clean driving record, and proof of insurance.
• Strong proficiency with Microsoft Office Suite products.
• Suitable home workspace that allows for a productive office environment.

Nice To Haves

• Nursing home experience.
• Insurance or Insurance Customer Service License.

Responsibilities

• Coordinate with the Insurance Producer after enrollment to support a seamless transition and successful customer service experience.
• Follow up with enrolled members to answer questions, provide assistance to members or their families, and share periodic plan updates.
• Provide frontline support as needed to members, partner facilities, and integrated care teams to help meet member and plan needs.
• Develop and maintain relationships with key network providers and facilities in the assigned region.
• Support regional network development activities needed to meet network adequacy requirements.
• Meet with members and/or their families at least monthly.
• Follow up on matters with which members are dissatisfied and report them to the plan.
• Develop and maintain reports, including member status, daily/weekly/monthly facility calendars, and issue tracking and management.
• Ensure all interactions with members comply with CMS regulations.
• Ensure that the required services are carried out for each member in the assigned group of nursing facilities.
• Perform other responsibilities as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed